The American Cancer Society has updated its prostate cancer screening guideline. a. Men should only be screened after they receive information about the uncertainties, risks, and potential benefits associated with prostate cancer screening.

PSA testing is now recommended with or without the digital rectal exam (DRE).

There is little evidence that the DRE adds significant benefit to the PSA test, except, perhaps, when the PSA is in the borderline range.

PSA value of 4.0 ng/mL be used as a reasonable threshold to trigger further evaluation.

There is a new recommendation for men with PSA values between 2.5 and 4.0 ng/mL. 25% of men with PSA levels between 2.5 and 4.0 ng/mL harbor prostate cancer and physicians should consider an individualized risk assessment for these men.

An individual assessment should take into account non–PSA risk factors, such as race, family history, results of previous biopsies, and DRE results.

ACS also now recommends that the PSA testing interval be reduced to every other year for men whose PSA level is under 2.5 ng/mL. Such a reduction in testing frequency will lead to significantly reduced false positives, unnecessary biopsies, and overdiagnosis, with only a negligible increase in missed cancers.

India would need nearly seven lakh doctors to meet its requirement in the health sector in the next 20 years, Medical Council of India (MCI) has said in its ‘Vision 2015’ document. The document prepared by the experts from across the country to reform the undergraduate and postgraduate course curricula, says even if the intake is increased from current 35,000 to 50,000, it will be in 2031 that the doctor–population ratio can meet 1: 1,000 as mandated by the Council. With the current intake of 35,000 by the existing 330 medical colleges, the shortfall of doctors by 2031 is estimated at 9.54 lakh, says the MCI while seeking immediate steps from the Health Ministry. Painting a dismal picture of the health sector, it points out that the current doctor–population ratio in India is 1:1,700 as compared to a world average of 1.5: 1,000. "The committee came to a consensus that targeted doctor population ratio should be 1: 1,000 by 2031," says the document. For achieving this target, the document has said that the current intake of medical colleges and the number of doctors should be doubled.

The vision document prepared by eight members group with George Mathew, Principal and Professor in GI Surgery, Christian Medical College, Vellore, as Convener has been put up on the council’s website for suggestions and objections from the concerned stakeholders till January 21 after which it will be submitted to the Ministry for its consideration. The undergraduate and postgraduate working groups were constituted in July 2010 to develop the ‘Vision’ with an aim to evolve a roadmap for the direction of medical education in the country in alignment with national needs as well as to evolve a broad policy regarding the emphasis, duration and curricular changes to make country’s medical education comparable to global standards.

As a short–term measure, the document has suggested immediate increase in the intake in existing medical colleges wherever there is adequate infrastructure of teachers, equipment and clinical load and to augment infrastructure in relation to clinical load by attaching established medical colleges to district level hospitals or secondary hospitals run by Government agencies. The vision document has proposed, as a mid–term suggestion, upgradation of existing larger district hospitals and augmenting their infrastructure to become community medical colleges through private public partnership or public private partnership. Starting new medical colleges and hospitals preferably in States and underserved areas with doctors and medical colleges are among the long–term measures proposed to be undertaken in five years duration. (Source: The Pioneer, January 10, 2011)

Congratulations to Dr. S Arulrhaj for Academic Laurels

Dr. S. Arul Rhaj M.D., FRCP., President, Commonwealth Medical Association is being appointed as the Adjunct Professor of Medicine by Dr MGR Medical University, Chennai for a period of 5 years! All of us know that Royal College of Glasgow has conferred FRCP on him in 2009.

Let us wish him many more such academic laurels! Message by Dr. K.Vijayakumar.

A one–year follow–up study on seniors who participated in a strength training exercise program shows sustained cognitive benefits as well as savings for the healthcare system. The research, conducted at the Centre for Hip Health and Mobility at Vancouver Coastal Health and the University of British Columbia, is published in the Archives of Internal Medicine. The study is the first to examine whether both cognitive and economic benefits are sustained after formal cessation of a tailored exercise program. It builds on the Brain Power Study, published in the January 2010 issue of Archives of Internal Medicine, which demonstrated that 12 months of once–weekly or twice–weekly progressive strength training improved executive cognitive function in women aged 65– to 75– years– old. Executive cognitive functions are cognitive abilities necessary for independent living.

(Dr Monica and Brahm Vasudev)

Having babies close together may increase younger child’s risk for autism

According to a study published in the journal Pediatrics, having babies close together appears to increase the risk of autism, and the more closely babies are spaced, the higher the risk that the younger one will be diagnosed with autism.

Measuring glycated hemoglobin levels may help identify prediabetes

Specifically, using HbA1c alone –– with a range of 5.5% to 6.5% defining prediabetes –– would identify a population with comparable risks for diabetes and heart disease (32.4% and 11.4%, respectively), according to a study in the American Journal of Preventative Medicine. But using a slightly higher cutoff –– beginning at 5.7% –– would identify increased risks of 41.3% for diabetes and 13.3% for heart disease.

(Dr GM Singh)

What is the risk of suicide for patients taking isotretinoin?

For some years there have been reports linking isotretinoin to depression or suicide in young patients. However, a review of the evidence found no causal relationship, and that the incidence of depression and suicide during isotretinoin therapy may be no greater than for the population in general. Acne itself is sometimes a cause of depression.

ICSI has revolutionized the treatment and improved the prognosis for fertility of men with very severe oligospermia, asthenospermia (low sperm motility), teratospermia (a higher rate of abnormal sperm morphology), and even azoospermia. This technique involves the direct injection of a single spermatozoon into the cytoplasm of a human oocyte, usually obtained from follicles produced under controlled ovarian hyperstimulation. This technique has also been successful in men with nonmosaic Klinefelter syndrome where spermatozoa are obtained from testicular biopsies.

If available, breastfeeding or breast milk should be used to alleviate procedural pain in neonates undergoing a single painful procedure compared to placebo, positioning or no intervention. Administration of glucose or sucrose had similar effectiveness as breastfeeding for reducing pain. The effectiveness of breast milk for repeated painful procedures is not established and further research is needed. These studies should include various control interventions including glucose/sucrose and should target preterm neonates.

7 years age: In accordance with Section 82 of Indian Penal Code, any act that is done by a child under seven years of age is not an offence.

7–12 years of age: In accordance with Section 83 of Indian Penal Code, a child between 7–12 years of age is presumed to be capable of committing an offence, if he attained sufficient maturity of understanding to judge the nature and consequences of his conduct on that occasion. This maturity is presumed in a child of 7–12 years age until the contrary is proved.

10 years age: In accordance with Section 369 of Indian Penal Code kidnapping or abducting child less than 10 years of age with intention to steal from its person is a criminal punishable offence.

14 years age: A child below 14 years of age cannot be employed to work in any factory or mine under Indian Factory Act 1948. A person completing 15 and up to 18 years is allowed to work as adolescent employee in a factory if a fitness certificate is issued by a competent registered doctor.

Women’s Health: Preventing Top 10 Threats (Mayo Clinic)

Blood poisoning (septicemia or sepsis)

Septicemia is a life–threatening infection marked by the presence of bacteria or their toxins in the blood. Septicemia commonly arises from infections in the lung, urinary tract, abdomen or pelvis. Often, it isn’t preventable, but you can take steps to avoid infections and to protect yourself from illnesses that weaken your immune system.

Wash your hands often.

Keep your vaccines current.

Seek prompt medical care for any serious infection.

Change tampons at least every six to eight hours and avoid using superabsorbent tampons.

Wipe from front to back after urinating and urinate after sex.

Lab Update

(Dr Arpan Gandhi and Dr Navin Dang)

Stool Examination

Diarrhea is a common symptom of a gastrointestinal disturbance. O & P (Ova and Parasite) testing: A microscopic evaluation of stool for parasites and the ova (eggs, cysts) of parasites. A basic test but very important!!

Medi Finance Update

What is the rate of standard deduction on the net annual value of income from house property?

Ans. 30% of net annual value shall be allowed as deduction from net annual value of income from house property.

Drug Update

List of Approved drugs from 01.01.2010 TO 30.4.2010

Drug Name

Indication

DCI Approval Date

Raltegravir (as Potassium) film coated Tablets 400mg

In combination with other anti retroviral agents for the treatment of human immunodeficiency virus (HIV–1) infection in treatment experienced patients with evidence of HIV–1 replication despite ongoing retroviral therapy

27–Jan–10

IMSA Update

International Medical Science Academy (IMSA) Update

Polio vaccination

The Advisory Committee on Immunization Practices has issued updated recommendations regarding routine poliovirus vaccination. The final dose in the series should be administered when the child is at least four years old.

IJCP Special

Dr Good Dr Bad

Situation: A patient with Mediclaim was advised to get admitted in a 5–bedded hospital. Dr. Bad: It does not matter. Dr. Good: Go to 15 bedded hospital. Lesson: Mediclaim requires admission in hospital with minimum 15 beds (in C–Towns, it can be 10 bedded).

Make Sure

Situation: A patient with acid peptic disease was denied any painkiller for his distressing illness. Reaction: Oh, my God! Why did you not give him nimesulide? Lasson: Make sure to prescribe nimesulide as it is safe in acid peptic disease.

Lighter Side of Reading

An Inspirational Story (Contributed by Dr Mukul Tiwari)

A Story of Elephant

A Guy, one day was passing the elephants in a zoo, he suddenly stopped, confused by the fact that the huge creatures were being held by only a small rope tied to their front legs. No chains, no cages. It was obvious that the elephants could, at anytime, break away from the ropes they were tied to but for some reason, they did not. That Guy saw a trainer nearby and asked why these beautiful, magnificent animals just stood there and made no attempt to break–away. "Well," he said, "You see, when they are very young and much smaller we use the same size rope to tie them and at that young age, it was enough to hold them. As they grow old, they are conditioned to believe they cannot break away. They believe the same old rope can still hold them, so they never try to break free." My friend was amazed.

These animals could at any time break free from their bonds but they never try because they believe they couldn’t, and were stuck right where they were.

Like the elephants, how many of us go through life hanging onto a belief that we cannot do something, simply because we failed at it once before? Lets try once again by attempting to grow further.

………………………………

eQuiz

Read this…………………

An otherwise healthy (Is this the missing word? Plz check) 30–year–old male patient presents with two days of cough, phlegm, fever with chills, shortness of breath and right-sided pleuritic chest pain. On examination, he is febrile, tachycardic and has clinical features consistent with right lower lobe consolidation. BP is 120/80 mmHg. Which of the following is the next best step in his management?

A. The MCI has been spreading false scare in order to push up its case for the BRHC course conceived by the health Minister. The facts are as follows:

The current MCI chief, Dr. Sarin has stated as follows: “We assessed that the country needs about seven lakh doctors. Even if we increase our current intake from current 35,000 to 50,000 it will be 2031 when we would be able to meet the target. We can’t wait that long". http://edunews.successcds.net/union–govt–cancels–the–2011–national–common–medical–entrance-test-1363.html#more-363

Seven lakh doctors for 1.25 billion population means 1 doctor per 1714 population, while the availability of doctors in India in July 2005 as per MCI data, revealed by the then Minister of State for Health and Family Welfare, Panabaka Lakshmi, was 1:781 (1:1,722 if only allopathic doctors were considered). http://www.financialexpress.com/news/doctorpopulation-ratio-stands-at-11-722/139…

It is obvious that Dr. Sarin has goofed up his figures. It is also obvious that he has a bias against non-allopathic systems of medicine for which the MOH has a separate department and which are fully legal and constitutional and for which a huge amount of tax payers’ money is spent. The MCI has no right to dismiss or wish away the ISM.

Conclusion: There is no shortage of doctors in India. It is well known to health specialists that a nation’s health depends not so much on the doctor: population ratio as upon the doctor: nurse ratio and the improvement of infrastructure (bed: population ratio; transport; communication; alleviation of hunger; increase in health budget; provision of clean water and sanitation etc.). The remedy lies in giving incentives to doctors to work in rural areas by providing proper living and working conditions for doctors in such areas and providing them adequate opportunities for career development. An embargo should be put on opening medical colleges or higher institutes in urban areas. Even the existing medical colleges in urban areas can be shifted to rural areas. This would raise lot of revenue for the government. Land would be available cheap or free in rural areas and the urban land thus vacated can be sold at a premium. The staff can be shifted en masse because they are under an obligation to work anywhere. Building new hospitals in rural areas will be a sure way of rural development. Existing hospitals attached to medical colleges can be sold to private corporate sector at high premium, just like off–loading the Nav Ratna industries. All this is eminently practicable. Dr. Sarin and his team, who are all eminent doctors, certainly know the basics of health. They are doing a disservice to the profession and the country by spreading false information in order to tout the political and individual whims of the health minister. The IMA ought to strongly protest against this to the PM, the HM and the MCI, asking for immediate withdrawal of the wrong and motivated statement of the MCI chief. Regards: Dr MC Gupta

Public Forum

(Press Release for use by the newspapers)

Hookah As Bad As Smoking

An hour of puffs from a hookah packs the same carbon monoxide punch as a pack–a–day cigarette habit, said Padma Shri & Dr. B.C. Roy National Awardee, Dr. KK Aggarwal, President, Heart Care Foundation of India.

Hookahs have grown in popularity in recent years and Hookah bars have appeared in cities all over the world that allow people to smoke the water pipes.

Users inhale tobacco smoke after it bubbles through water, a process that some people think filters toxins from the tobacco.

Hammond and a student, in a study published in a letter in the Journal of the American Medical Association, recruited 27 students who smoked water pipes for an hour on three different evenings in April 2006. Another five students didn't smoke the hookahs but stayed in the room with those who did. The participants abstained from water pipe smoking for 84 hours before taking part in the study; the bowls of their water pipes were filled with water and 10 grams of Al Fakher mu'assal tobacco, then heated with charcoal.

Researchers monitored carbon monoxide in the breath of the participants both before and after the experiment using a machine designed to detect if people are smokers.

The exhaled carbon monoxide in participants was an average of 42 parts per million, higher than that reported in cigarette smokers (17 parts per million). The study also found that carbon monoxide levels grew in the room where the subjects smoked hookahs and might reach environmentally unhealthy levels, as determined by the federal government, during longer sessions.

Smoking a water pipe for 45 minutes produces 36 times more tar than smoking a cigarette for five minutes.